Volume 209 Issue 7

Medical assistance in dying may disrupt therapeutic relationships and will challenge beliefs

Leeroy William

A new Australian strategy should finally reduce the significant national burden of diabetes-related foot disease

Peter A Lazzarini · Jaap J van Netten · Robert A Fitridge · Ian Griffiths · Ewan M Kinnear · Matthew Malone · Byron M Perrin · Jenny Prentice · Paul R Wraight

Worldwide, over 100 organisations are using the Grading of Recommendations Assessment, Development and Evaluation approach; it is thus essential that clinicians using formal guidelines become familiar with the GRADE approach

Waleed Alhazzani · Gordon Guyatt

A fit, active 80-year-old man presented to the emergency department with double vision

Sarah L Stevens · Daniel Schweitzer

A 71-year-old man taking immunosuppressive medication for a renal transplant developed four chronic lower leg ulcers over 6 months

Emily R Sideris · Ludi Ge

Early diagnosis and coordinated care are critical for achieving the best outcomes for patients with liver disease

Timothy Papaluca · Alexander JV Thompson

Testing patients at high risk and eradicating infection may reduce bleeding risk, but further pharmaco-economic analysis is required

Carlos Sostres · Angel Lanas

An Australian-led international and multidisciplinary collaboration has developed new recommendations to improve the care, health outcomes and quality of life of women with PCOS

Robert J Norman · Helena J Teede

Multicentre randomised controlled trials examining the efficacy of the chronic liver failure program are warranted

Jeyamani Ramachandran · Monowar Hossain · Chris Hrycek · Edmund Tse · Kate R Muller · Richard J Woodman · Billingsley Kaambwa · Alan J Wigg

Testing for infection should be considered in patients at high risk of peptic ulcer bleeding

Justin CH Ng · Neville David Yeomans

The gut microbiota is a key cause, and potential cure, of modern gut disorders including inflammatory bowel disease, liver diseases, metabolic syndrome and obesity

Lauren S White · Johan Van den Bogaerde · Michael Kamm

The emphasis on prompt diagnosis and treatment of irritable bowel disease offers the possibility of altering the natural history of disease and reducing disability

Emily K Wright · Nik S Ding · Ola Niewiadomski

To the Editor: Behavioural and psychological symptoms of dementia can manifest as aggression directed towards staff or other residents,1 often culminating in recourse to the local emergency department as a “permanent solution”. What does the law say? Under Division 2, User Rights Principles 2014 (section 96-1, Aged Care Act 1997), the only circumstances in which a provider may ask a care recipient to leave a residential care service are if (i) the service is closing; or (ii) the service no longer provides suitable accommodation and care (as assessed by an aged care assessment team or at least two medical or other health practitioners chosen by the recipient who are competent to assess their care needs) and the provider has not agreed to provide the care that the recipient presently needs; or (iii) the recipient no longer needs the care provided, as assessed by an aged care assessment team; or (iv) the recipient has not paid any agreed fees for a reason within their control; or (v) or the recipient has intentionally caused serious damage to the service or serious injury to staff or another care recipient; or (vi) the recipient is away continuously for 7 days or more from the service for reasons not permitted by the Aged Care Act or an emergency. The approved provider must neither imply nor take action to make the care recipient leave, unless suitable alternative accommodation is available that is affordable and meets the care recipient’s needs. Written notice must be given of the decision and reasons for it. A person cannot be asked precipitously to leave a nursing home or, in practical terms, hospital staff or family cannot be told that a bed is no longer available without adhering to the guidelines above. Intention regarding injury and behavioural and psychological symptoms of dementia is complex and cannot be used as grounds for discharge without proper assessment. An alternative is to use the Dementia Behaviour Management Advisory Service and Severe Behaviour Response Teams (24-hour helpline: 1800 699 799), which provide clinical support for carers of people with behavioural and psychological symptoms of dementia. Aged care consumers need to be aware of their rights around security of tenure, and facilities should be resourced sufficiently to fulfil their commitments under the Aged Care Act to care for residents with behavioural and psychological symptoms of dementia.

Carmelle Peisah · Tiffany Jessop · Henry Brodaty

To the Editor:The Reflection article by Bravery1 reminded us of the disability rights movement slogan “Nothing about us without us” and prompted us to reflect on the ways in which expert patients, carers, health and patient advocates, and community members contribute to medical student teaching at the School of Medicine at the University of Notre Dame Australia, Fremantle. Their partnership is crucial to the School being able to meet the standards — (2.1.4) “the medical education provider relates its teaching, service and research activities to the health care needs of the communities it serves,” and (4.6) “learning and teaching methods in the clinical environment promote the concepts of patient centred care and collaborative engagement” — of the Australian Medical Council’s Standards for Assessment and Accreditation of Primary Medical Programs.2 From the School’s inception in 2005, academic staff and community members have worked collaboratively, in the spirit of reciprocity, to teach students. First-year students engage with teenage mothers, expert patients and their families, older people in community-based physical activity classes, and patients in general practice settings, and they live with a family in the Wheatbelt region in Western Australia to learn first-hand about the social determinants of health and the health needs and priorities of Australians in rural settings — a program undertaken in collaboration with the medical students from Curtin University.3 By the end of the pre-clinical years, students have been taught by sex workers, people of diverse sexualities, and children with cancer via panel discussions and in clinical skills sessions, and they have shadowed a patient to witness their lived journey in a community radiology clinic. A one-week Kimberley placement provides insight into health issues in remote areas by living and working in community settings such as Indigenous communities, pastoral stations, art galleries and sporting organisations. These opportunities pave the way for collaboration between the School and other professions and industries — two-way interprofessional learning in real-world settings. As stated by Bravery,1 the impact on students is palpable. They appreciate the opportunity to understand people’s personal perspectives4,5 and apply this understanding to their medical practice — “the [rural or remote placement] guides my work now … It comes back to me; it helps me understand rural people’s lives”.6

Donna B Mak · Jelena Maticevic · Brian D Power

Dr Bryony Thompson helps doctors and genetic counsellors bring a little more certainty to patients on the receiving end of genetic testing

Cate Swannell

The 2018 Australian Museum Eureka Prize winners have been announced with health and medical personnel picking up several gongs. The UNSW Eureka Prize for Excellence in Interdisciplinary Scientific Research was won by the Optical Physics in Neuroscience team at the University of Queensland, which has devised cutting-edge methods for studying how our brains work to detect gravity and motion. Using optical trapping and novel microscopes, they successfully imaged the functioning brain circuits that process gravity and motion and combine this information with other senses. The Australian Infectious Diseases Research Centre Eureka Prize for Infectious Diseases Research was won by the CR Air team, including Metro North Hospital and Health Service; The Prince Charles Hospital; QIMR Berghofer Medical Research Institute; Children’s Health Queensland; University of Queensland; Griffith University; Gold Coast Health; and Queensland University of Technology. The CF Air team uncovered the process by which the deadly pathogens causing airway infections are transmitted between cystic fibrosis (CF) patients. Their research has attracted considerable attention from the CF community, impacting clinical practice and policy and ultimately reducing infection rates amongst patient groups. Professor Tony Weiss, AM, from the University of Sydney, won the Johnson and Johnson Eureka Prize for Innovation in Medical Research, for developing an adhesive surgical glue that quickly seals wounds without the need for common staples. The technology, made from natural elastic protein, has the potential to revolutionise treatment at emergency sites and was recently sold to an international pharmaceutical company. The ANSTO Eureka Prize for Innovative Use of Technology was won by Professor Wendy Erber, Dr Kathryn Fuller and Henry Hui, from the University of Western Australia, who figured out how to detect abnormal chromosomes inside leukaemia cells. This fast, accurate and sensitive automated method can detect just one leukaemia cell in 10 000 normal cells, a major advance that will lead to personalised treatments and better patient care. The UNSW Eureka Prize for Scientific Research was won by Professor Sally Dunwoodie, from the Victor Chang Cardiac Research Institute, and her multidisciplinary team who discovered the potential of vitamin B3 to treat a molecular deficiency causing miscarriages and multiple types of birth defects. Their finding could prevent developmental defects through a common dietary supplement, which may transform the way pregnant women are cared for around the world. https://australianmuseum.net.au/2018-eureka-prizes-winners Professor Grant McArthur has been awarded the 2018 Tom Reeve Award for Outstanding Contributions to Cancer Care by the Clinical Oncology Society of Australia. Professor McArthur is inaugural Lorenzo Galli Chair in Melanoma at the University of Melbourne; Consultant Medical Oncologist, Melanoma and Skin Cancer Service at the Victorian Comprehensive Cancer Centre, Head of the Cancer Therapeutics Program, at the Peter MacCallum Cancer Centre and most recently, was appointed Executive Director of the Victorian Comprehensive Cancer Centre in Melbourne. He also holds other senior appointments, including Professorial Fellow in the Department of Medicine at St. Vincent’s and Geelong Hospitals, Victoria and Professorial Fellow in the Department of Pathology at the University of Melbourne. His award citation read: “Professor McArthur epitomises the values of COSA and of Tom Reeve. His respect for the contribution of all members of the multidisciplinary team sets an example for all colleagues and influences the culture of health care delivery for multidisciplinary clinicians and researchers. This approach to his colleagues defines his clinical, education and research activities. Like COSA, Professor McArthur works across the pillars of education, advocacy, research and practice and has a life-long commitment to establishing collaborative networks that improve outcomes for people with cancer.” Velma Herwanto, a PhD student from the Westmead Institute and University of Sydney, has received best international abstract in the upcoming International Sepsis Forum. The abstract was based on Ms Herwanto’s research on developing a test for sepsis. There is no test for early detection of sepsis, meaning early warning signs may go unnoticed until symptoms become critical. However, in the future Ms Herwanto’s research could help develop a simple blood test that could reduce mortality rates. “I’m analysing the metabolic profile of blood samples taken from sepsis patients, then comparing these profiles to the severity of infection and sepsis to look for patterns,” she said. So far, she has found that patients with more severe sepsis have more reduced mitochondrial function. Eventually, Velma hopes to find a biomarker that can help predict sepsis. https://www.westmeadinstitute.org.au/news-and-events/2018/stopping-sepsis-in-its-tracks

Cate Swannell

This calendar will be updated each month. If you have an event you would like to add, please include relevant details in an email to cswannell@mja.com.au. The full version of the calendar is available online at https://www.mja.com.au/careers October 24-26 44th International Mental Health Nursing Conference: Mental health is a human right, Cairns, QLD 24-26 Urological Society of Australia and New Zealand – New Zealand Section Meeting 2018, Palmerston North, NZ 24-27 27th National Conference on Incontinence, Hobart, TAS 24-27 General Practice and Acute Medicine Update Refresher, Melbourne, VIC 25-26 Emergency Nurse Leadership Program, Melbourne, VIC 25-27 ANZCA Perioperative Medicine SIG Meeting, Melbourne, VIC 25-27 Colorectal Surgical Society of Australia and New Zealand and the Colon and Rectal Surgery Section of the RACS Spring Colorectal Meeting 2018, Fremantle, WA 25-28 2018 RANZCR 69th ASM, Canberra, ACT 25-28 Australian College of Rural and Remote Medicine and Rural Doctors Association of Australia: Rural Medicine Australia 2018, Darwin, NT 26 New Zealand Sports Medicine Conference 2018, Nelson, NZ 26-27 Innovations in Rehabilitation and Mental Health Conference, Melbourne, VIC 26-27 2018 RACP Northern Territory ASM: Vulnerable populations, Darwin, NT 26-28 Australian Anaesthesia Allied Health Practitioners 3rd National Conference, Sydney, NSW 27 Alfred Pain Symposium: Opioids: friends or foes, Melbourne, VIC 27-28 Acute Stroke Treatment Seminar, Sydney, NSW 28 Oct-1 Nov Cutaneous Biology 2018, North Stradbroke Island, QLD 31 Oct-2 Nov 20th Australasian Gastro-Intestinal Trials Group ASM 2018, Brisbane, QLD 31 Oct-1 Nov 2nd Annual National NDIS Mental Health Conference, Melbourne, VIC NOVEMBER 1-2 HNEkidshealth Conference 2018, Newcastle, NSW 1-3 International Union Against Sexually Transmitted Infections Asia Pacific Sexual Health Congress 2018, Auckland, NZ 1-4 General Practice and Acute Medicine Update Refresher, Brisbane, QLD 2 2018 RACP Tasmanian Conference, Burnie, TAS 2-3 Australasian Gynaecological Endoscopy and Surgical Society Focus Meeting, Canberra, ACT 2-3 2018 New Zealand Melanoma Summit, Auckland, NZ 3-4 14th National Laser and Cosmetic Medicine Conference 2018, Brisbane, QLD 4-7 Australasian Genomic Technologies Conference, Glenelg, SA 6-9 5th National Indigenous Drug and Alcohol Conference, Adelaide, SA 7-9 Nepean Blue Mountains Local Health District Together Achieving Better Health Conference, Penrith, NSW 7-9 Paediatric Society of New Zealand 70th ASM 2018, Nelson, NZ 7-9 Australian Association for Adolescent Health 2018 Youth Health Conference, Gold Coast, QLD 7-10 RANZCP Faculty of Psychiatry of Old Age and the Asian Society Against Dementia Conference 2018, Melbourne, VIC 8-10 New Zealand Anaesthesia Annual Scientific Meeting 2018, Auckland, NZ 8-10 RANZCP Faculty of Psychiatry of Old Age and the Asian Society Against Dementia Conference 2018, Melbourne, VIC 9 Health Information Technology, Perth, WA 9 Australian Research Alliance for Children and Youth: Creating the Healthiest Nation Through Addressing Inequality Forum, Sydney, NSW 10-17 2018 IEEE Nuclear Science Symposium and Medical Imaging Conference, Sydney, NSW 11-14 11th International Conference on Frontotemporal Dementias, Sydney, NSW 13-14 6th National Brain Injury Conference, Brisbane, QLD 13-15 Clinical Oncology Society of Australia 2018 ASM, Perth, WA 16-18 General Practice Conference and Exhibition, Melbourne, VIC 17-18 Critical Care Imaging Interpretation 2018, Noosa Heads, QLD 17-21 50th Annual Scientific Congress of the Royal Australian and New Zealand College of Ophthalmologists, Adelaide, SA 18-20 Australian and New Zealand Falls Prevention Society Conference, Hobart, TAS 18-22 Australasian College for Emergency Medicine, 35th ASM, Perth, WA 20-21 Food Futures Conference, Brisbane, QLD 20-21 2nd National Aboriginal and Torres Strait Islander Suicide Prevention Conference, Perth, WA 21-22 2nd Australasian FASD Conference 2018, Perth, WA 21-23 11th Hospital in the Home ASM: LEARN: Lead, engage, aspire, research, negotiate, Brisbane, QLD 21-23 Australian Association of Gerontology Conference 2018, Melbourne, VIC 21-23 New Zealand Society of Gastroenterology ASM 2018, Dunedin, NZ 21-24 6th Asia-Oceanian Conference of Physical and Rehabilitation Medicine combined with the Rehabilitation Medicine Society of Australia and New Zealand's 3rd Annual Scientific Meeting, Auckland, NZ 21-24 Australian and New Zealand Association of Psychiatry, Psychology and Law 2018 Annual Conference: Sins of the past: reflections and future directions, Hobart, TAS 21-24 General Practice and Acute Medicine Update Refresher, Sydney, NSW 22 Bond University Sustainable Healthcare Awards 2018, Gold Coast, Queensland 22-23 New Zealand Respiratory Conference 2018, Auckland, NZ 22-23 2nd World Indigenous Suicide Prevention Conference, Perth, WA 23 RECOVER Forum 2018: Innovation in rehabilitation, South Brisbane, QLD 23-25 Queensland Hand Surgery Society Conference, Noosa, QLD 23-25 Australia and New Zealand Conference on Sarcopenia and Frailty 2018, Dunedin, NZ 26-28 1st International Motor Impairment Conference, Sydney, NSW 26-29 8th Gathering of Healing Our Spirit Worldwide, Sydney, NSW 27 Osteoarthritis Summit, Canberra, ACT 27 2nd Annual Conference of the Alliance for the Prevention of Mental Disorders, Noosa, QLD 27-28 7th Annual NHMRC Symposium on Research Translation: Ensuring value in research, Sydney, NSW 28-30 40th Annual Society for Mental Health Research Conference: Collaboration, Noosa, QLD 29 Nov-1 Dec ASID New Zealand Annual Meeting, Dunedin, NZ 30 2018 International Indigenous Allied Health Forum, Sydney, NSW DECEMBER 1 Australasian Gynaecological Endoscopy and Surgery Society Pelvic Anatomy Dissection Cadaveric Workshop, Brisbane, QLD 1 RACP South Australian ASM, Adelaide, SA 2-6 Australasian Society for Immunology 47th ASM 2018, Perth, WA 3-4 Stop Domestic Violence Conference, Gold Coast, QLD 4-5 NSW Hip Festival 2018, Sydney, NSW 4-6 3rd Global Adolescent and Young Adult Cancer Congress, Sydney, NSW 7 Doctors Assisting in South Pacific Islands Annual Charity Ball, Sydney, NSW 2019 TBA World Congress on Inflammation, Sydney, NSW JANUARY TBA 12th Australasian Conference on Health Informatics and Knowledge Management 14-16 31st Australian Council for Health, Physical Education and Recreation International Conference, Canberra, ACT FEBRUARY TBA The Australian and New Zealand Glaucoma Society ASM 8-10 Australasian College of Sport and Exercise Physicians Annual Scientific Conference, Queenstown, NZ 15-16 Vitamin C Symposium 2019, Auckland, New Zealand 23 Australasian Faculty of Rehabilitation Medicine NZ Symposium 2019, Waipuna, NZ 25 Feb-1 Mar Leadership and Innovation in Health, Melbourne, VIC MARCH TBA Medical Parents of Australia and New Zealand Conference, Gold Coast, QLD TBA Australasian Academy of Cerebral Palsy and Developmental Medicine 10th Biennial Scientific Conference, Perth, WA 1-2 Australia and New Zealand Strabismus Society Meeting (Squint Club), Parkville, VIC 1-3 International Medicine in Addiction Conference, Melbourne, VIC 6-8 International Medicine Society of Australia and New Zealand Autumn Scientific Meeting 2019, Auckland, NZ 7-10 New Zealand Pain Society ASM, Christchurch, NZ 17-20 Perinatal Society of Australia and New Zealand Annual Congress, Gold Coast, QLD 20-23 International Society for Gastrointestinal Hereditary Tumours (InSiGHT) Meeting, Auckland, NZ 22-24 ASOHNS 69th Annual Scientific Meeting, South Brisbane, QLD 24-27 15th National Rural Health Conference, Hobart, TAS 25-30 International Neuromodulation Society 14th World Congress, Sydney, NSW 25-26 No More Harm National Conference: Bullying, Harassment and Discrimination, Gold Coast, QLD 27-28 9th Annual Australian Healthcare Week, Sydney, NSW 27-30 8th World Glaucoma Congress, Melbourne, VIC 29 Mar-2 Apr Annual Scientific Meetings of The Australia and New Zealand Society of Respiratory Science and The Thoracic Society of Australia and New Zealand, Gold Coast, QLD APRIL 7-10 2019 Australian Pain Society 39th ASM, Gold Coast, QLD 11-13 Biennial meeting of the Asia Pacific Society of Sexual Medicine, Brisbane, QLD 12-15 ISN World Congress of Nephrology 2019, Melbourne, VIC 13-16 Urological Society of Australia and New Zealand 72nd ASM, including the ANZUNS 24th annual meeting, Brisbane, QLD 30 Apr-3 May Australasian College of Emergency Medicine Winter Symposium 2019, Rotorua, NZ MAY TBA RACP Congress 2019, Auckland, NZ 5-7 20th Annual Scientific Meeting of the Australasian College of Phlebology, Cairns, QLD 13-15 Australian and New Zealand Addiction Conference: Prevention, treatment, recovery, Gold Coast, QLD 16-18 ASID Annual Scientific Meeting 2019, Darwin, NT 18-21 Australasian College of Dermatologists Annual Scientific Meeting, Melbourne, VIC 25-30 International Neuromodulation Society 14th World Congress, Sydney, NSW 30-31 Nextcare Health Conference, Brisbane, Queensland JUNE 17-20 Lowitja Institute International Indigenous Health and Wellbeing Conference, TBC 18-20 Global Health Security 2019, Sydney, NSW 25-28 International Society on Early Intervention Conference 2019: Research to practice in early intervention: an international perspective, Sydney, NSW JULY 27-30 Transplantation Society of Australia and New Zealand PGC and ASM, Sydney, NSW AUGUST 3-6 Human Genetics Society of Australasia 43rd ASM, Wellington, NZ 8-11 67th Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand, Adelaide, SA 9-11 13th Annual Australia and New Zealand Endovascular Therapies Meeting, Adelaide, SA 12-16 17th Deaf Blind International World Conference 2019, Gold Coast, QLD SEPTEMBER 7-8 Rural Dermatology Meeting, Orange, NSW 15-19 14th World Congress on Inflammation, Sydney, NSW 29 Sep-2 Oct 18th Biennial Clinical Neurophysiology Workshop, Gold Coast, QLD OCTOBER TBA RACGP conference, GP19 2-4 AIDA Conference 2019, Darwin, NT 14-18 World Congress of Intensive Care, Melbourne, VIC 20-23 11th Development Origins of Health and Disease World Congress, Melbourne, VIC NOVEMBER 17-19 10th World Congress of Itch, Sydney, NSW DECEMBER 5-7 Preventing Overdiagnosis, Sydney, NSW 2020 APRIL 2-4 Exercise and Sports Science Australia Research to Practice 2020, Perth, WA MAY 16-18 Australasian College of Dermatologists Annual Scientific Meeting, Adelaide, SA 2021 NOVEMBER 10-13 XIII International Congress of Dermatology, Melbourne, VIC DECEMBER TBA FIGO World Congress of Gynaecology and Obstetrics, Sydney, NSW

Cate Swannell

Med J Aust 2018; 209 (7 Suppl).